Prevalence and factors associated with dyslipidemia among adolescents in Saudi Arabia.

Dyslipidemia is a major risk factor for atherosclerosis. Screening for dyslipidemia at an early age is essential to prevent and control its consequences. This study aimed to determine prevalence of dyslipidemia and its correlates among adolescents in Saudi Arabia. Data of 5854 adolescents aged 10-19 years from all 13 regions of Saudi Arabia were obtained from the Jeeluna study; a national cross-sectional, multistage stratified cluster sample survey. Dyslipidemia was defined based on the National Heart Lung and Blood Institute and National Cholesterol Education Program guidelines for adolescents. We found that a quarter of Saudi adolescents have dyslipidemia (males: 33.3%, females: 17.9%). Significant variation was observed by region (p < 0.001). Prevalence of abnormal Total Cholesterol was 6.7%, LDL-C 7.1%, HDL-C 12.8%, Non-HDL-C 8.3%, and Triglycerides 9.6%. Factors independently associated with dyslipidemia were male gender (OR = 2.19, 95% CI 1.78-2.70, p < 0.001), BMI (underweight OR = 0.80, 95% CI 0.69-0.94, overweight OR = 1.76, 95% CI 1.50-2.06, obese OR = 2.80, 95% CI 2.34-3.34, p < 0.001, vs. normal) and serum ferritin (high OR = 7.02, 95% CI 1.49-34.79, low OR = 0.82, 95% CI 0.67-1.01, p = 0.04 vs. normal) and ≥ 1 daily intake of carbonated beverage (OR = 1.10, 95% CI 1.00-1.20, p = 0.03 vs. no or not daily intake). Public health interventions for improving lipid profile of adolescents are urgently needed.

Lifestyle habits in Saudi adolescents with diagnosed diabetes: An opportunity for health promotion.

AIMS: This study assessed lifestyle and health behavior habits among a representative sample of Saudi adolescents with self-reported diabetes and compared them to non-diabetic peers. METHODS: This was a nested case-control study, from the Jeeluna cohort, a nationwide, cross-sectional study of 12,575 Saudi boys and girls aged 10-19 years. Non-diabetic adolescents were matched to those with diabetes on a ratio of 4:1 based on age, gender and region. Retained information from the original study included: socio-demographics, lifestyle behaviors, tobacco/substance use, screen use, anthropometric measurements, and laboratory results. RESULTS: The prevalence of diabetes was 0.7% (n = 87). Overall, 65% of diabetic participants were males, and 22.4% aged ≤14 years. Overall, both groups had low rates of healthful habits in their diet and physical activity. Both groups had similar rates of tobacco use, and high digital screen time. Adolescents with diabetes had more consistent sleeping pattern, were more likely to be on a diet, thought they spent enough time with their physician and obtained medical information more often from their health clinic. They were also more likely to feel down and to chat more often. CONCLUSION: Adolescents with diabetes remain far from guideline targets but seem predisposed to better lifestyle and have more access to health as compared to their non-diabetic peers.

World Health Organization and knowledge translation in maternal, newborn, child and adolescent health and nutrition.

The World Health Organization (WHO) has a mandate to promote maternal and child health and welfare through support to governments in the form of technical assistance, standards, epidemiological and statistical services, promoting teaching and training of healthcare professionals and providing direct aid in emergencies. The Strategic and Technical Advisory Group of Experts (STAGE) for maternal, newborn, child and adolescent health and nutrition (MNCAHN) was established in 2020 to advise the Director-General of WHO on issues relating to MNCAHN. STAGE comprises individuals from multiple low-income and middle-income and high-income countries, has representatives from many professional disciplines and with diverse experience and interests.Progress in MNCAHN requires improvements in quality of services, equity of access and the evolution of services as technical guidance, community needs and epidemiology changes. Knowledge translation of WHO guidance and other guidelines is an important part of this. Countries need effective and responsive structures for adaptation and implementation of evidence-based interventions, strategies to improve guideline uptake, education and training and mechanisms to monitor quality and safety. This paper summarises STAGE's recommendations on how to improve knowledge translation in MNCAHN. They include support for national and regional technical advisory groups and subnational committees that coordinate maternal and child health; support for national plans for MNCAHN and their implementation and monitoring; the production of a small number of consolidated MNCAHN guidelines to promote integrated and holistic care; education and quality improvement strategies to support guidelines uptake; monitoring of gaps in knowledge translation and operational research in MNCAHN.

Determinants of adolescents' perceptions on access to healthcare services in the Kingdom of Saudi Arabia: Jeeluna national survey findings.

OBJECTIVES: The study aimed at identifying the determinants of adolescents' access to healthcare services. SETTING: Intermediate and secondary schools across all 13 regions in the Kingdom of Saudi Arabia (KSA) from 2011 to 2012 through the Jeeluna national school-based survey. PARTICIPANTS: Intermediate and secondary school students participated in the study. A multistage, cluster, random sampling technique was used. Participants responded to a self-administered questionnaire that addressed several domains. MAIN OUTCOME MEASURE: Adolescents' perception of access to healthcare services. RESULTS: Twenty-five per cent of participants reported difficulty in accessing healthcare. Women, early (younger) adolescents and adolescents with three siblings were less likely to report difficulty in accessing healthcare than men, late (older) adolescents and those with fewer than three siblings. Adolescents from low-income families and those with either mental or physical illness were more likely to report difficulty in accessing healthcare than adolescents from higher income families and those without mental or physical illnesses. CONCLUSIONS: Disparities in access to care exist between certain subpopulations of adolescents. Efforts are needed to support enhancing access and making it more equitable. Training for healthcare professionals and targeted health policies are necessary to improve adolescents' access to health services in the KSA. TRIAL REGISTRATION NUMBER: RC08-092; King Abdullah International Medical Research Centre.

Child mortality in Saudi Arabia: Time for action at all levels.

BACKGROUND AND OBJECTIVES: Although child mortality is declining in Saudi Arabia, new trends and causes are emerging. The objective of the study is to determine the causes of child death in a tertiary care hospital in Saudi Arabia and to identify its preventable causes and associated risk factors. METHODS: A modified UNICEF Multiple Indicator Cluster Survey (MICS) was used to analyze all deaths among children under the age of 18 which occurred at the King Abdullah Specialized Children's Hospital (KASCH) between 2010 and 2016. RESULTS: After reviewing all the death charts of 1138 children, the team determined that 15% (172) of all deaths could have been prevented and the preventability increased with age. Only 2% of the neonates died of preventable causes, while 53% of the children of 6 years of age or older died of preventable causes. The highest percentage of preventable deaths occurred in children aged 13-18 years (39.3%), followed by the age group of 6-12 years (32.4%) and the age group of 29 days to 5 years (13.9%). All 966 (85%) deaths from biological causes were considered to be unpreventable. Among the preventable causes, 142 (82.5%) had injuries and 30 (17.4%) were sudden unexpected infant death (SUID) with no documented autopsy or death scene investigation, and thus it was considered preventable by the researchers. The 5 major causes of deaths secondary to injuries were motor vehicle accidents (MVA) accounting for 86 deaths (60.6%), followed by drowning accounting for 19 deaths (13.4%), child maltreatment accounting for 13 deaths (9.2%), fire and weapon accounting for 12 deaths (8.5%), and finally home accident (fall, poisoning, suffocation) accounting for 12 deaths (8.5%). CONCLUSION: The State Child Death Reviews Board should thoroughly investigate deaths due to SUID and injuries by identifying the factors that contribute to the implementation of preventive strategies.

Underweight, body image, and weight loss measures among adolescents in Saudi Arabia: is it a fad or is there more going on?

BACKGROUND AND OBJECTIVE: Adolescence is considered to be a pivotal point in which optimum nutrition and eating habits are developed. Although tackling the obesity epidemic has been much discussed, addressing the issue of underweight and body image is often neglected. This study was carried out to get a better understanding of underweight status among adolescents in Saudi Arabia, and exploring self-perceptions of body image and weight loss measures among underweight adolescents. METHODS: Data from Jeeluna®, a national cross-sectional school-based survey were utilized. Jeeluna® assessed the health status and health-risk behaviors of adolescents in school through data obtained by a self-administered questionnaire, anthropologic measurements, and laboratory investigations. RESULTS: A total of 12,463 adolescents participated. Eighteen percent of adolescent males and 12.4% of females were found to be underweight, representing 14.9% of adolescents collectively. Forty-five percent of underweight participants were happy with their weight. Underweight females between the age group of 10 and 14 years were the most likely to believe that they still need to lose weight (16.0%) followed by females aged 15-19 years (9.7%). Underweight females aged 10-14 years were also the group most likely to engage in purging (1.6%). Stepwise logistic regression found that the strongest association with being underweight was with having a lower household income (OR 2.0, CI 1.5-2.7) and having more than 5 siblings (OR 1.8, CI 1.5-2.3). CONCLUSION: Underweight status is prevalent among adolescents in Saudi Arabia and deserves more attention as a public health issue. Distorted body image and disordered eating behaviors exist, necessitating further investigation of underlying causes.

Urgent Need for Adolescent Physical Activity Policies and Promotion: Lessons from "Jeeluna".

Physical inactivity is a growing concern in Kingdom of Saudi Arabia (KSA) and globally. Data on physical activity (PA) trends, barriers, and facilitators among adolescents in KSA are scarce. This study aims to identify PA trends amongst adolescents in KSA and associated health and lifestyle behaviors. Data from "Jeeluna", a national study in KSA involving around 12,500 adolescents, were utilized. School students were invited to participate, and a multistage sampling procedure was used. Data collection included a self-administered questionnaire, anthropometric measurements, and blood sampling. Adolescents who performed PA for at least one day per week for >30 min each day were considered to "engage in PA". Mean age of the participants was 15.8 ± 0.8 years, and 51.3% were male. Forty-four percent did not engage in PA regularly. Only 35% engaged in PA at school, while 40% were not offered PA at school. Significantly more 10-14-year old than 15-19-year-old adolescents and more males than females engaged in PA (<0.01). Mental health was better in adolescents who engaged in PA (<0.01). Adolescents who engaged in PA were more likely to eat healthy food and less likely to live a sedentary lifestyle (<0.01). It is imperative that socio-cultural and demographic factors be taken into consideration during program and policy development. This study highlights the urgent need for promoting PA among adolescents in KSA and addressing perceived barriers, while offering a treasure of information to policy and decision makers.

A nationwide study of asthma correlates among adolescents in Saudi Arabia.

BACKGROUND: Asthma is a chronic airway inflammation disease that is frequently found in children and adolescents with an increasing prevalence. Several studies are linking its presence to many lifestyle and health correlates. The objective of this study was to explore these correlates and find characteristics of self-reported asthmatics among adolescents in Saudi Arabia. METHODS: This is a cross-sectional, school-based study carried out in all 13 regions of Saudi Arabia. Sampling was randomly done from intermediate and secondary school students. Data in our study consisted of demographic characteristics, health conditions and lifestyle patterns and were compared between the two groups: asthmatics versus non-asthmatics. Comparison between the two groups was done by analyzing our data using Statistical Analysis Software SURVEYFREQ procedure (SAS Version 9; SAS Institute, Cary, NC). RESULTS: Among a sample of 11,348 participants, the prevalence of self-reported asthma was found to be 8.2%. Various characteristics were found significantly different between the 2 groups including the gender, the weight, the family's education, and dietary patterns. Self -reported asthmatic were more likely to be males, overweight or obese, with a lower father's level of education and a higher consumption of milk and power drinks. CONCLUSION: Asthma disease remains prevalent among adolescents in Saudi Arabia and requires higher awareness and better guidance for its prevention and treatment. Further efforts should focus on health promotion and lifestyle wellness to support preventive efforts of this chronic disease condition.

Correction: Identifying obesity/overweight status in children and adolescents; A cross-sectional medical record review of physicians' weight screening practice in outpatient clinics, Saudi Arabia.

[This corrects the article DOI: 10.1371/journal.pone.0215697.].

Identifying obesity/overweight status in children and adolescents; A cross-sectional medical record review of physicians' weight screening practice in outpatient clinics, Saudi Arabia.

BACKGROUND: BMI is a feasible and recommended measure for overweight and obesity screening in children and adolescents. The study aimed to determine how often physicians correctly identified obesity/ overweight status in children and adolescents by using BMI percentile charts. METHODS: This retrospective cross-sectional study reviewed the paper medical records of children and adolescents (6-14 years) who visited family medicine and pediatric outpatient clinics (Jan-June 2012) in a medical city in Riyadh. Investigators calculated BMI percentiles (using height, weight, age and gender data retrieved from the records) in order to identify patient weight status. Physician documentation of obesity/overweight diagnoses in patient problem lists were cross checked against their BMI percentile to assess the accuracy of physicians' identification of weight status. The recommended management plan for identified patients was also recorded. RESULTS: A total of 481 charts were reviewed, 213 (44%) children were seen by family medicine physicians and 268 (56%) by pediatricians. The sample was equally distributed by gender. Height was undocumented for 13% (71) of visiting patients. Eighteen percent of patients (86) were classified as overweight (35)/obese (51) according to age and sex adjusted BMI percentile. Physicians' correctly identified and documented weight status in 20% of overweight/obese patients: 17 out of 86 subjects. Weight status identification was higher among pediatricians-25% as compared to family medicine physicians-10% [p = 0.08]. Dietary referral was the most common management plan for the identified children. Physicians were more likely to identify obese children {≥95th} compared to overweight {≥85th - 95th} children. Subjects whose BMI for age classified them into the highest BMI percentile category {≥95th} were more likely to be correctly identified (29%) compared to those classified within {≥85th - 95th} category-6% [p = 0.007]. CONCLUSION: Physician identification of obesity/ overweight status for children and adolescents was low, irrespective of their specialty, and despite the condition being prevalent in the sample. Future research that concentrates on interventions that may improve documentation of obesity/overweight diagnoses and parameters needed for BMI indices would be beneficial.

The Reliability and Validity of the Arabic Version of the Composite Abuse Scale.

Research that examines intimate partner violence (IPV) in the Arab world has been hampered by a lack of comprehensive valid and culturally appropriate measures. The purpose of this study was to test the reliability and validity of the Arabic version of the Composite Abuse Scale (CAS) in a sample of 299 Saudi women recruited from primary healthcare centers. Confirmatory factor analysis (CFA) did not support the original four-factor structure of CAS. Exploratory factor analysis revealed that the item pool reliably distinguished four different types of abuse (physical abuse, verbal abuse, sexual abuse, and control). Two items were dropped from the scale leaving a 27-item scale. The final four-factor model with 27 items was supported through further CFA, including analyses supporting the fit of the four-factor model on a higher level, second-order concept (IPV). Total and subscales CAS scores demonstrate excellent to good reliability and evidence of concurrent validity based on correlations with established measures of depression (Center for Epidemiologic Studies-Depression [CESD]) and posttraumatic stress disorder (PTSD) (PTSD Checklist-Civilian Version [PCL-C]).

Suicidal Thoughts, Attempts and Motives Among University Students in 12 Muslim-Majority Countries.

There is a scarcity of research on suicidal phenomena in the Muslim world. Therefore, this study aimed at investigating the self-reported prevalence of suicidal thoughts, attempts and motives in 12 Muslim countries. A total of 8417 (54.4% women) university students were surveyed by means of a self-report questionnaire. Overall, 22% of the participants reported suicidal ideation and 8.6% reported attempting suicide. The odds of suicidal thoughts were elevated in Azerbaijan, Indonesia and Saudi Arabia, while reduced ORs were recorded in Egypt, Jordan, Lebanon and Malaysia. While odds of suicide attempts were high in Azerbaijan, Palestine and Saudi Arabia reduced odds ratios (OR) were detected in Indonesia, Iran, Jordan, Lebanon, Malaysia and Tunisia. Taking drugs and using a sharp instrument were the two most frequently used methods to attempt suicide. Only 32.7% of attempts required medical attention. Escape motives were endorsed more than social motives by participants who attempted suicide. Suicidal behaviors were more frequent in women than in men. Compered to men, fewer attempts by women required medical attention. Moreover, our results show that making suicide illegal does not reduce the frequency of suicidal behavior. Results from this comparative study show that suicidal thoughts and attempts are frequent events in young adults in countries where religious scripture explicitly prohibit suicide and the frequencies of nonfatal suicidal behavior show large variation in nations adhering to the same religion.

Sleep deprivation: prevalence and associated factors among adolescents in Saudi Arabia.

OBJECTIVE: A limited number of studies have examined sleep deprivation (SD) among adolescents in Saudi Arabia. This study estimates SD prevalence and associated factors within a nationally representative sample of adolescents in Saudi Arabia. METHODS: A secondary data analysis of Jeeluna®, a national cross-sectional school-based survey, was undertaken. Jeeluna assessed health risk behaviors and health status among adolescents (aged 10-19 years) in schools across Saudi Arabia. Based on self-reports of daily average sleep duration, binary logistic regression was used to investigate potential association among SD, socio-demographics, and various health behavior factors. RESULTS: Data from 12,121 adolescents (male 51%, female 49%) were analyzed. Early- and middle-stage adolescents constituted the majority (81%) of the sample. SD (sleep <7 h/day) was reported by 46% on weekdays and 33% on weekends. Three-fourths of all adolescents reported feeling unrefreshed on awakening. The adjusted odds ratio (A-OR) for SD was higher for adolescents of older age (18-19 years) (OR 1.18, CI 1.05-1.32), female gender (OR 1.23, CI 1.14-1.34), lower perceived socioeconomic status (OR 1.51, CI 1.28-1.78), and those eating less than three main meals per day (OR 1.17, CI 1.09-1.27). In contrast, A-ORs were lower among adolescents reporting television and computer screen exposure of ≥2 h per day (OR 0.81, CI 0.75-0.88; OR 0.83, CI 0.77-0.91), and those taking daytime naps (≥3 days) per week (OR 0.87, CI 0.81-0.94). CONCLUSIONS: Sleep deprivation is highly prevalent among adolescents in Saudi Arabia, with reported prevalences being higher on weekdays versus weekends. The study identifies multiple associated factors that can inform preventive strategies and programs to support adolescent sleep and well-being.

Factors mediating the impacts of child abuse and intimate partner violence on chronic pain: a cross-sectional study.

BACKGROUND: Most research on the health impacts of intimate partner violence (IPV) and child abuse has been conducted in Western countries and may not be generalizable to women living in different contexts, such as Saudi Arabia. Chronic pain, a disabling health issue associated with experiences of both child abuse and IPV among women, negatively impacts women's well-being, quality of life, and level of functioning. Yet, the psychosocial mechanisms that explain how abuse relates to chronic pain are poorly understood. We developed and tested a theoretical model that explains how both IPV and child abuse are related to chronic pain. METHODS: We recruited a convenience sample of 299 Saudi women, who had experienced IPV in the past 12 months, from nine primary health care centers in Saudi Arabia between June and August 2015. Women completed a structured interview comprised of self-report measures of IPV, child abuse, PTSD, depressive symptoms, chronic pain, and social support. Using Structural equation modeling (SEM), we analyzed the proposed model twice with different mental health indicators as mediators: PTSD symptoms (Model 1) and depressive symptoms (Model 2). RESULTS: Both models were found to fit the data, accounting for 31.6% (Model 1) and 32.4% (Model 2) of the variance in chronic pain severity. In both models, mental health problems (PTSD and depressive symptoms) fully mediated the relationship between severity of IPV and child abuse and chronic pain severity. Perceived family support partially mediated the relationship between abuse severity and depressive symptoms. CONCLUSIONS: These results underscore the significance of considering lifetime abuse, women's mental health (depressive and PTSD symptoms) and their social resources in chronic pain management and treatment.

Prevalence and predictors of metabolically healthy obesity in adolescents: findings from the national "Jeeluna" study in Saudi-Arabia.

BACKGROUND: Obese children and adolescents may vary with respect to their health profile, an observation that has been highlighted by the characterization of metabolically healthy obesity (MHO). The objectives of this study were to examine the prevalence of MHO amongst obese adolescents in Saudi-Arabia, and investigate the anthropometric, socio-demographic, and lifestyle predictors of MHO in this age group. METHODS: A national cross-sectional school-based survey (Jeeluna) was conducted in Saudi-Arabia in 2011-2012 (n = 1047 obese adolescents). Anthropometric, blood pressure and biochemical measurements were obtained. A multicomponent questionnaire covering socio-demographic, lifestyle, dietary, psychosocial and physical activity characteristics was administered. Classification of MHO was based on two different definitions. According to the first definition, subjects were categorized as MHO based on the absence of the following traditional cardiometabolic risk (CR) factors: systolic blood pressure (SBP) or diastolic blood pressure (DBP) >90th percentile for age, sex, and height; triglycerides (TG) > 1.25 mmol/L; high density lipoprotein-cholesterol (HDL-C) ≤1.02 mmol/L; glucose ≥5.6 mmol/L. The second definition of MHO was based on absence of any cardiometabolic risk factor, according to the International Diabetes Federation (IDF) criteria. RESULTS: The prevalence of MHO ranged between 20.9% (IDF) and 23.8% (CR). Subjects with MHO were younger, less obese, had smaller waist circumference (WC) and were more likely to be females. Based on stepwise logistic regression analyses, and according to the IDF definition, body mass index (BMI) (OR = 0.89, 95% CI: 0.84-0.93) and WC (OR = 0.97, 95% CI: 0.96-0.98) were the only significant independent predictors of MHO. Based on the CR definition, the independent predictors of MHO included female gender (OR = 1.76, 95% CI: 1.29-2.41), BMI (OR = 0.97, 95% CI: 0.94-1.00), and weekly frequency of day napping (OR = 1.06, 95% CI: 1.00-1.12). Analysis by gender showed that vegetables' intake and sleep indicators were associated with MHO in boys but not in girls. CONCLUSION: The study showed that one out of five obese adolescents is metabolically healthy. It also identified anthropometric factors as predictors of MHO and suggested gender-based differences in the association between diet, sleep and MHO in adolescents. Findings may be used in the development of intervention strategies aimed at improving metabolic heath in obese adolescents.

Relationship of media exposure to substance use among adolescents in Saudi Arabia: Results from a national study.

BACKGROUND: With limited social options, young Saudis are increasingly relying on media for entertainment. The media impact has been greatest among the younger generation, which constitutes half of the population of the Kingdom of Saudi Arabia (KSA). Therefore, this study aims to examine the association between exposure to varied types of media and substance use among adolescents in the KSA and explores whether these associations differ by gender. METHODS: Data were obtained from a national cross-sectional survey of school students aged ten to 19 years (N = 12121). A self-administered questionnaire was used to assess exposure to three types of media: television, the Internet and video games with the use of legal substances such as cigarette/shisha smoking, solvents sniffing and misuse of medications, and illegal substances, such as alcohol, marijuana and other illicit drugs. RESULTS: Logistic regression analyses revealed that the odds of using tobacco, legal and illegal substances were higher for students who were watching television, surfing the Internet, or playing video games for more than two hours compared with their peers who watched less than two hours (P < 0.05). For males, results showed the heavy and light use of the Internet were both significantly associated with smoking. Whereas for females, only excessive use of the Internet was associated with smoking. CONCLUSION: Despite the conservative nature of the Saudi society, findings showed a significant association between tobacco or substance use and media exposure among adolescents. This suggests increased attention to the growing role media might play in shaping adolescents health risk behaviors in the KSA.

Child maltreatment prevention strategies: Saudi youth perspectives.

BACKGROUND AND OBJECTIVES: Child maltreatment (CM) is a global problem that has long-term negative outcomes. The objective of this study is to explore the knowledge and perceptions of youth regarding CM prevention. METHODS: The study was conducted in Saudi Arabia using International Child Abuse Screening Tool (ICAST). Answers to open-ended questions were analyzed and a list of CM prevention strategies was generated. RESULTS: Participants identified a range of preventive strategies that were grouped into three main themes: 1) collective preventive efforts; 2) recognizing and responding to CM; 3) gaining closure. For each overarching theme, a list of subthemes were derived. Subthemes included raising awareness through the mass media; school professionals' capacity building and curriculum advancement; strengthening family relationships; enact CM preventive legislations and policies; monitoring media content and video games and limiting access to firearms for the first theme. The second theme comprised the subthemes reporting services and protective services. As for the third theme it included rehabilitation; punishment for CM crimes and connection to spirituality. CONCLUSION: Gathering youth perspectives on CM prevention will help us in designing future prevention strategies.

Reliability and validity of the Arabic PTSD Checklist Civilian Version (PCL-C) in women survivors of intimate partner violence.

Although intimate partner violence (IPV) survivors are at high risk for developing posttraumatic stress disorder (PTSD), PTSD has been considered a disorder specific to Western culture. There is a lack of reliable and valid measures of PTSD symptomology available in the Arab world, and there is still no clear evidence about the underlying factor structure of PTSD symptomology in the context of IPV. Thus, in the present study we investigated the construct validity (factor structure), internal consistency, and concurrent validity of a translated version of the PTSD Checklist Civilian Version (PCL-C) in a sample of 299 Saudi women who had experienced IPV. Four competing models (DSM-IV, Emotional Numbing, Dysphoria, and Dysphoric Arousal) were specified and estimated using confirmatory factor analysis (CFA). The five-factor Dysphoric Arousal model provided superior fit with the data compared to the alternative models, supporting construct validity of the Arabic PCL-C. The factor loadings for the five-factor Dysphoric Arousal model ranged from .31 to .83. A relatively high correlation between the Arabic PCL-C and Arabic Center for Epidemiologic Studies-Depression (CES-D) Scale (r = .78, p < .05) provided evidence of concurrent validity. The total scale also demonstrated internal consistency reliability (α = .89). Overall, the study supports the Dysphoric Arousal model in representing PTSD symptoms among IPV survivors, the reliability and validity of the Arabic version of PCL-C, and the cross-cultural applicability of PTSD symptoms.

Predictors of adolescents' mental health problems in Saudi Arabia: findings from the Jeeluna® national study.

BACKGROUND: Depression and anxiety among adolescents require further attention as they have profound harmful implications on several aspects of adolescents' wellbeing and can be associated with life threatening risk behaviors such as suicide. OBJECTIVE: To examine the underlying risk factors for feeling so sad or hopeless and for feeling worried among adolescents in Saudi Arabia. METHODS: Data from Jeeluna® national survey was used. A cross-sectional, multi-stage, stratified, cluster random sampling technique was applied among a sample of students aged 10-19 years attending intermediate and secondary schools in Saudi Arabia. A self-administered questionnaire assessing several domains, including feeling so sad or hopeless and worried, was used to collect data. Logistic regression models were fitted to determine the different factors associated with mental health. RESULTS: A sample of 12,121 students was included in this study. Feeling so sad or hopeless and feeling worried were significantly more prevalent among females and older adolescents (p < 0.0001). The results showed that poor relationship with parents, negative body image, and chronic illness to be significantly associated with feeling so sad or hopeless and worried. CONCLUSIONS: Symptoms suggestive of mental health problems among adolescents in Saudi Arabia are prevalent and deserve special attention. Adopting effective strategies, including regular screening and intervention programs are highly needed to better address, detect, and control early signs of these problems.